4012 Pumice LaneKNLITSON MORTGAGE
AND FINANCIAL CORPORATION
MINNEAPOLIS, MINN. 55401
4-30-70 70 1305
DETACH AND RETAIN THIS STATEMENT
THE ATTAGHED CHECK IS IN PAVMENT OF ITEMS DESCRIBED BELOW.
IF NOT CORRECT PLEASE NOTIFV US PROMPTLY. NO REGEIPT DESIRED.
Sp. Assess. - Sewer & Water Lateral
1/2/7
Allar, Gordon #12280
1,615.00
/ mt
CITY OF EAGAN
, 3795 Pilot Knob Road Eagan, MN 55122
' PHONE: 454-8100
BUILDING PERMIT $8 9 640. Receipt #
. . _ tz
401`? ? ?niCF L
Site Address
r - Erect ?
Lot _I- Block % Sec/Sub. i'i: 7 Alter ?
Parcel # Repoir ?
Enlarge ?]
('?r?on '?11 ?r
a Name
w Move p
3 ?irr, f.r;
4012 Pa??
Z Address
Demolish ?
? -
City .' ap3n Phone 1i54- 557 ?` -- Grade ?
Approvals
o Nome BE:riSOYi i;otas ti„
?
pQ i:it:? j i!,>l,:e za:3s.: iR'?•&:. k.
Address Assessment-
U
w Woter & $ew.
~ Cit ? +? 1 Phone
F
?
Name Police
Fi
F W re
v? Address Eng.
-
¢ W Cit Phone Plonner
Council
I hereby acknowledge that I have read this opplicotion and state that Bldg. Off. _
the information is correct and agree to comply with a!I oppiicable
State of Minnesota Statut=s and City, of Eagan Ordinances. APC
Signature of Permittee - --
tl l111 r
., rd a
N2 4258
5597
il 6, 77
Occupancy -
Zoning
Fire Zone
Type of Const. _
# Stories
Front - 16
Depth _ ?'-
ft.
ft.
Fees
I
Ri
Permit 30.00
Surcharge y'• 5r)
Plan check _
SAC
Water Conn. _
Water Meter
I Total
A Building Permit is issued to: _ v- a -- on the express condition that
all work shall be done in accordance with all applicable State of Minn=scto Statutes and City of Eacan Ordinances.
Building Official - - -
PenniF $k Date loued POnnklw
Plumbing
Mechanical
INSPECTIOMS DATE INSP. Rough-In Firal
Footings !2?? Date Insp. Date IrKp.
Foundation Plumbing
Frome/ins. Mechanical
Final.
? YS ? )
CITY OF EAGAN
- _3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 i
PHON E: 454-8100
BUILDING PERMIT Receipt#
To be used for Est. Value Date
FIREPI.ACE 119
Site Address F'i•' iC.':*' !' ' OFFI CE USE ONLY
Lot ? Block ? Sec/Sub.`-x.??,.,s; OnSiteSewage Occupancy
MWCC System Zoning
Parcel No.
On Site Well (Actual) Const
s
Name City Water (Allowable)
W
; 4012
Address PRV Required # of Stories
? Cit Ll-{??"' Phone /r'`
Y BoosterPump Length
Depth
p Name F:C S.F. Total
,
z?
o q •, 7 Ax?' `S ti??.i{
Address Footprint S.F.
U ? Ciry Phone APPROVALS FEES
? W Engr./Assess. Permit "
?y Name
W
? Planner Surcharge
_g
¢ Address
Council
Plan Review
Z
aw Cit Phone
Y
Bldg. Off.
SAC, City
I hereby acknowledge that I have read this application and state that the Variance SAC, MWCC
information is correct and agree to comply with all applicable State of Water Conn.
Minnesota Statutes and City of Eagan Ordinances. Water Meter
Signature of Permittee Road Unit
A Building Permit is issued to: Treatment P1
on the express condition that all work shall be done in accordance with all
Parks
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official TOTAL
Permit No. Permit Molder Date Telephone #
Plumbing
H.V.AC.
Electric
Softener
Inspection Date Insp. Comments
Footings I
Footings II
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Final Plbg.
Bldg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
CITY OF EAGAN Remarks
Addition CEDAR GROVE #7 Lot 1 Bik 2 Parcel 10 16706 010 02
Owner " - r(?ar S?reet 4012 PL1ul1C@ I,dAe State Ea9an. MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 6'1 1970 58.18 2.08 28 Paid
* SEWER LATERAL 1971 20
WATERMAIN
* WATER LATERAL j, 1971 1,615.00 80.75 20 Paid
WATER AREA
* STORM SEW TRK 1971 20
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 230.00 2006 12-3-69
BUILDING PER.
SAC 200.00 2-3-fig
PARK
INSPECTION RECORD Control No.
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number: ????????
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: t. aTa? BLOCu: APPLICANT:
4012 MI.iMIGE IAME Ol"qE' S? NOME CARE T. REPAIRS
f;EpA#t QRUVE 7 F'N (612) 154--3402
PEpMITU§yqjYptF TYPE OF WORK: itf pAxR
w#-hnkr'; ttf--RiaOFtNa
Permit No. PermR Holder Date Telephone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Comments
Footingsl
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Fnal Htg.
Orsat Test
Final Plbg. Pibg. InspeCtor- Notily Plumber
COnst. Meter
EngrJPlan
Bldg. Fina!
Deck Ftg.
Deck Final
Well
Pr. Disp.
CITY OF EAGAN
„ ., 3795 Pilot Knob Road Eugun, MN 55122 N2 4258
? PHONE: 454-8100
5597
BUILDING PERMIT APPLICATION ReceiPt #
$8,640
.
April 6, 77
To be used for F3milY Room Addn. Date , 19
Site Address 4012 Pumice Ln Erect ? Occupancy I
Blo
k Se
t
1
/S
b
L
?'
G
Z Alter ? Zoning R1
u
-.
-
c
c
.
,
o
-
-
Repair ? Fire Zone _
Parcei #
Enlarge Type of Const.
a Gordon Al1ar
Name Move ? # Stories
3 Address 40119 P+imi ra i.n Demolish .? Front 16 ft.
? E
454
5575 Grade ? Depth 18 ft.
-
agan phone
Cit
? Nam Benson Cons t. Approvals Fees
?p e
ou Address 20675 Howland Ave. W.
t- r:... T ..1s.4 77,. DL.,,..e /.GO_74nG
?
W
z
FD
z
W
Nome
Address
I hereby acknowledge thot I have read this application and state that
the information is correct and agree to comply with all appiicable
Stote of Minnesota Statutes and City of Eagan Ordinonces.
Signature of Permittee
G d All
Assessment _
Water & Sew.
Police
Fire
Eng.
Planner -
COUnCil _
Bldg. Off. -
APC
Permit Jv.vv
Surcharge 4.50
Plon check
SAC
Waier Conn. _
Water Meter
Total 34.50
A Building Permit is issued to: Or OII aY on the express condition that
all work shall be done inAccordynce wit all applicable Stote of Minnesoto $tatutes and City of Eagan Ordinances.
Building Official
CITY OF EAGAN No 1510 4
t* '' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 -
BUILDING PERMIT PH ON E: 454-8100
Receipt ? tl r1 r
? '."°
To be used for FIREPLACE Est. Value $1, 000 Date JUNE 1 1988
Site Address 4012 PUMICE LN
Lot 1 Block 2 Sec/Sub. CEDAR GROVE 7TH
Parcel No.
x Name DANIEL WILD
z Address 4012 PUMICE LN
? City EAGAN Phone 454-6288
,o Name ICI, INC
? Q Address 626 ARMSTRONG AVE
? City ST PAUL Phone 222-2422
r?
OW
F w Name _
? Address
u
Q W City_
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State of
Minnesota Statutes and y gan Ordin nces.
Signature of Permittee w
A Building Permit is issued to: I INC
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official?Lleu??,t?-
1
OFFICE USE ONLY
On Site Sewage Occupancy
MWCC System Zoning
On Site Well (Actual) Const
City Water (Allowable)
PRV Required # of Stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit 24.00
Planner Surcharge .50
Council Plan Review
Bidg. Off. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL 24.50
EAGAN TOWNS H I P
BUILDING PERMIT
owne: ? -?`-..
• .................•------._... . ._......_...... `_--•--•--••--•---••--•---•••--••-----•---••
Address (Present) -. _•-•-•........-----................`...-....--••--••-• .............
Builder -••-••-•• ..............•-•-•---•-••-••-•.....•--•-••--•--••--•---••-----••----•---•-••--••--.--•
Address ..--••-------------•-•-----•--•----••--••--•-----......-•---•--••-••••••••---•-•••--•---••----
DESCRIPTION
N° 21'71
Eagan Township
Town Hall
Dale ................ ...... •• •.................
:....
5iories To Be Used For Fron! Depth Height Est. Cos! ' Permit Fee Remarks
? /? ?
?„ a? o.? ar ?--+--? ?--? • ? jo ? .?-<..,F=c? ..?7;` f.?-ti?-??
LOCATION
Street, Road or other DescripYion of Location I Lo! Block Addition or Trac!
Z ?-.•-? .?--? -7
This permit does not auihorise the use of streets, roads, alleys or sidewalks nor does ii give the owner or his agent
the right to create any si2uation which is a nuisance or which presen3s a hazard to the health, safety, convenience and
general welfare fo anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
p, ihai ..._C 3 .?e -•z•.,•• -•-•-----..hasPermission to erect a ---? ..... ` ';'7--' - ?J?'? ..... upoa
c...?..?.?-:..-=•-••------••-•-•--•-...---•--• "?`? ?`"
This is to ceriif .•-
.April 11,
!he above described premise subject to the provisions of the Building Ordinance for Eagan 1b`wnship ad pd ted. •
1955.
....................... -- --..•`•'•-:.....,?.=-'.''`__':---•---•---°°•-•-•-••• Per ............... ?-?.?- ?cc......? .................
....••-
Chairrt(an of Tnwn Board Building Inspector
r- - 6
4i Y 1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS ? 5 / D
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL UNITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: Valuation: Date: ?" (y
?
Site Address pu,mAlL J r1 ? OFFICE USE ONLY
Lot ? Block
Parcel/Sub
Owner
Address L?() 1 L 't"'v ?h ??-Q LAJ
Ci y/ ip Code C-,4 .v S?? 2 Z-
Phone
? ^ .
Contractor ?-c- .
Address
City/Zip Code
Phone > Z 2- 2 4f Z Z
Arch./Engr.
Address
City/Zip Code
On site sewage Occupaney
MWCC system Zoning
On site well Aetual Const
City water Allowable
PRV required 4k of stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr/Assess Permit 4 c?
Planner Surcharge •5 ?
Council Plan Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
Phone #
BUILDIi3G Pi?.RNiIT P.;rPLICNTIO?T
Date : /I/ (° ?
LAT Z BLOCK ca. ADt7TTiON d?-°QCf 02rad f? 7
PAIZCEL & SECTIO?7 INNPIBER IF UidPLATTED
AA17RFSS OF PARCEL '?LD / aF-Ul tti1 i c. el e?..a qee,) e,
?
l;ORTc?GOCCUPANCY / USE ?'??- •
0
..r`.+rJ' t .L7.'ilAT'.y'.+D COSS
(?r,o??o? Ad R It TELEPHOPdE hT0.
?DRESS
COt:T:t'P.ACTOR e) L°!J S D?, a a.? S`?• TELEPHOTIE TTO.
ADUa2E5S o? D?0 7 5 ? O u? Q x1 $4
tlote° Inclucle s3.te plano buil.ding plans, ancl energy calculations with tfixs
apnlication
5i_qned
JrPICE USE
Q0
V.ALU.t? i IO;;i ?
9? ?
SAC
Wr'?^aER C0::WEC^TOA
x,)A'!'ER HE3'Et`2
BUZLDSNG PEWIT F?'N:
5i7RCHAItGE P'EE
PI,Eki Cr:ECI{ FEL
PAFtIC DEDICATIWT rEE
OTHr,R
TOTAL*
.17/ .?
soa
A.PPROVALS :
.1SSE5SiJ1E1111T CLEtZI{ BUILDI23G DEPT. POZ,ICE DEP2'.w?_._?
FJA'+"ER & SEti7Ei2 DEPs. FIIL DEPT. PA;'2IC DEPT.
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CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
INSPECTION RECORD Control No. 0208
PERMIT TYPE: gUILDING.
Permit Number: 000228
Date Issued: 0 4/ 13 / 9 2
SITE ADDRESS: LOT: 1
4012 PUMICE LANE
GEDAR GROVE 7TH
PEM?jC pffRayffi
REMARK5: RE-ROOFIPIG
BLpCK: z APPLICANT:
6ENE'S HOME GARE
(612) 454-3402
TYPE OF WORK:
& REPAIRS
REPAIR
r- . .
%
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
t.:
PERMIT TYPE:
Permit Number:
Date Issued:
BUILpING
00@228
04/13/92
SITE ADDRESS:
4012 PUMICE LANE
LOT: 1 BLOCK: 2
CEDAR GROVf 7TH
DESCRIPTION:
PERMIT
Permit Type
Waark Type
MISCELLANEOUS
REPAIR
R-3
5 511 1_Z
in ?? r?°? ;
? %4 ?
REMARKS: (; Ey I NID
RE-ROOFINIi
FEE SUMMARY: vaLuATZON $3,0e0
Base Fee $54.80
Surcharge „$1.50
7ota1 Fee $55.50
?p C? OR• - Applicant - ST. ?§WNER:
CONIEAE IN-dME CARE & REPAIRS 14543402 0902716 WILD DANIEL
2017 FLINT LN 4012 PUMICE lM
EACaN MN 55122 EAGAN MN 66122
(612) 454-3402 (612)454-6288
?I t?ereby ackni??i?.edge t?ia t I 9ha?ve re a? this applica?timn and state that tF?e
e,inf.4rm,?tian is,e_ c arr,?can ?! ar? ;?.eve ?o cQrt?ply w?th.3 a1:1 ?.pplic ;a b?;-e State ?+f Mn.m ;
Statutes nnd Gattyof Eagan Ordinances.
:
e, e
ERM
f?Ao ?&A,r rni
I SUED BY: SIGNATUR
Control No. 0208
PERMIT #
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs. .
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date Val uat i on of work
Site Address: ?A??'5
STREET STE #
.
Ten ant Name :.?.?r?,?
LOT BLOCK SUBD. P.I.D. #
Descri ti on of work:
The appl i cant i s: ? Owner M Contractor El Other (Describe)
Name Pho ne
PrOpeity LAST F1RST
Owner adaress
STREET STE #
C i ty State Z i p 3.3?/c;1a
Company Phone ?/.j'%f?-
Contractor Address License #e?VQ71 Exp. ?-_.? :
C i ty State Z i p
Company Phone
At'ChiteCt/
Engineer Name Registration
? #
Address ?
City State 'Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that th e information is
correct and agree to comply with all applicable State of Minnesota Statu tes and City of
Eagan Ordinances. _
Signature of Applicant: ?
. . .?? ?v? ???¦
BUILDING PERMIT TYPE
? 01 Foundation O 05 Apt. Bldg E3 09 Basement Finish
? 02 SF Dwg. O Ob Garage/Accessory ? 10 Swim Pool
? 03 Two family E3 07 Fireplace E3 11 Res. Add./Porch
? 04 Multi-fam. T.H. E3 08 Deck ? 12 Ccmm./Ind.
WORK TYPE
El 31 New '
? 32 Addition
? 33 Alterations
)A 34 Repair
O 35 Tenant Finish
0 36 Move
GENERAL INFORMATION --
Const. (Actual)
(Allowable)
UBC Occupancy ..°?
Zoning
# of Stories
Length
Depth
APPROVALS
O 37 Demolish
? 99 Undefined
Basement sq. ft.
lst F1. sq. ft.
2nd*Fl. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
?..
Planning Building
Engineering Variance
REQUIRED INSPECTIONS ?? ?? ?? ? ?? ???o r-
? Site ? Footing ? Framing
11 Wallboard ? Final ? Oraintile
O Insulation
O Fireplace
Permi t Fee 5q.06
Surcharge
Plan Review License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
vatuat;on: s -.?000
- ;
? f-3 Pj,tbl ixjac.
O 14 Agricultural
N 13 -Mi scel l aneous
MWCC System
City Water
PRV Required
Booster Pump
. Fire Sprinkler
Census Code -
SAC Code
Assessments
?.
SAC %
SAC Units
EAGE:N TOWNSHIP
3795 Pilot Knob Rosd
St. Paul, MinaesoCa 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date:nAramhar 1 3 9Fi9
Numb e r • ?5ca,1
Billing Name:cPda ,,,ra,v.,c-on?.a, .t ,?„?r .; on Site Address: 401 Pumi,nQ Lanp_ 1-9_7
Owaer: Cedar Grove Cons,t,ruction
Plumber; Stein Inc.
tion of
Billitlg AddZ'E:ss-7343 _nngord Blvd. EaGt
South Saint Paul, Minn.
Meter Size Connection Chg. 2*30.00 nd 12/3/69
Meter No. l Permit Fee 7•50 Pa. 12/3/69
Meter Reading IMeCer Dep.
Meter Sealed: Yes lAdd'1 Chg.
NO ( Total Chg.
Building is a;
Residence_..&x _
tRultiple A'o. Units
Commercial
Industria 1
Other
Inspected by
Date
Remarks:
By:
Chief Inspector
In consideratioa of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work ia accordance with the rules and
re$ulations of Eagan Township, Dakota County, Mianesota.
By: Mary Rnderson
Cedar Grove Construction Co.
Please notify the above office when ready for inspection and connection.
EAGl3N TOWNSHIP
3795 Pilot Kriob Road
St. Paul, Minnesota 55111
Telephone 454•5242
PERMIT FOR SEWER SERVICE CONNECTION
.
DATE• .. [lmr.em?hpr, 1a1?:j?....` NUM$ER ., 937 ?.
OWNER:rP.f1nr G oy onatrUc ion Co. Address 4012 Pumice Lane 1-2-7
PLUMBER _ Sj-?ei.lLIng. TYPE OF PIPE Cast Iron
r.?.?....?
D ESCRIPTION OF BUILDING
Industriall Commercial{ Residential { Multiple Dwelling I No. of units
xx
Location of Connections:
Connection Charge gnn nnT,L4/3/69
Permit Fee 7•50 pct 12/3/69
Street Repairs
ToCa 1
Inspected by:
DaCe
Remarks•
$y
Chief InspecCor
In coasideration of the issue and delivery to me of the above perm3.t, I
hereby agree eo do the proposed work in accordance with the rules and
regulations of Eagan Township, DakoCa-County, Nlinnesota
By?.?,??=-?;.:o e s s e r?
Cedar Grove Construction Co.
Please notify when ready for.iaspection and connecCion aad before any portioa
of the work is covered.
, , Iw
a
MUNICIPALITY OF: Eagan Township
RE: Gordon Lee Allar - Lot 1, Block 2, Cedar Grove No. 7
Enclosed please find check in the amount of $1,615.00 , for
payment of special assessments on the property described above.
Please ref'er to our file no. 12546 when returning.receipt.
Thank you,
MIDWEST TITLE GUARANTEE COMPANY
-60 E. 4th Street
St. Paul, Minnesota 55101
By f a
- - -----------
?
j Permit#: G? 71
? Permit Fee:
? Date Received:
i Staff: I
I I
?____--_-________J
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: G ? Site Address: P?? /--42 17 ?
Tenant: Suite #:
RESIDENT / OWNER Name: bq?'t Phone:
Address / City / Zip:
Applicant is: Owner Lii?o"ntractor ,
TYPE OF WORK Description of work: d ?-e
Construction Cost: Multi-Family Building: (Yes / No ?
CONTRACTOR Name: D 1147, A"e- __1?7_111I ? License #: °? 3 9-10 6 6 7
Address:
City: ? v /t- h Sv? lI ? state: A/' zip:
Phone: lPf 2 -r--7"4 -,F Contact Person: D-F`-r E?l/t
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
C8t@g01'y Submitted Submitted
(4 SubmissiOn type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
??.
x ? ? ? ?? ?' `-'J? ? X
ApplicanYs Printed Name Appl s Si ature
Page 1 of 3
Use BLUE or BLACK Ink
r
For Office Use 1
=1 I/
Permit
City of EaEd~ 1 Permit Fee: 105 • a5 1
3830 Pilot Knob Road
'It lei
Eagan MN 55122 Date Received: , 3 I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
OF
Date: Site Address: '7 d/ f ,~C Unit
Name: (s~lL d Phone:`I~ Z71~ G~/3
Resident/
Owner Address / City / Zip: ~ Ice Z-4-17 Q
Applicant is: X- Owner Contractor
Type of Work Description of work: `/h
Construction Cost: b o Multi-Family Building: (Yes / No __J
( Company: l-kwu',07 Contact: /11/76lsls~''J~G`
Contractor Address: l3V Or Se//, C-~ City: 13~~y
;State: Zip: JS 377 Phone:
License 0/ Sv 1' Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
a
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
I
Sewer & Water Contractor: Phone:
_w.
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of a
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code ust be completed within 180
days of ermit issuance.
Appl' ant's Printed N me A nts SibKature
Page 1 of 3